Overview
Anorectal strictures involve narrowing of the anal canal, often complicating conditions like inflammatory bowel disease, trauma, or previous surgeries, leading to difficulties in defecation. 7Diagnosis
Clinical assessment including history of trauma, surgery, or inflammatory conditions.
Endoscopic evaluation to visualize the stricture and assess its length and location.
Contrast imaging (e.g., barium enema) to confirm the stricture and evaluate the extent of involvement. 7Management
First-line treatments:
- Balloon dilatation under fluoroscopic guidance for benign strictures 5.
- Self-expanding metallic stents for palliation in malignant strictures 5.
Adjunctive treatments:
- Surgical anoplasty for anatomical correction, particularly in complex cases 7.
- Biodegradable stents as a novel approach for refractory benign strictures 3.
Other modalities:
- Endoscopic laser therapy, photodynamic therapy, and chemical ablation (e.g., ethanol injection) for palliative management in malignant cases 4.Special Populations
Pediatrics: Anaesthetic challenges exist, particularly with potential iatrogenic injuries during complex procedures like thoracoscopic repairs 1.
Comorbidities: Management in patients with multiorgan failure requires careful consideration due to increased risks, as seen in the case of multiorgan failure leading to mortality 1.Key Recommendations
Use fluoroscopically-guided balloon dilatation as a first-line approach for benign anorectal strictures to relieve dysphagia with high efficacy and minimal complications (Evidence: Strong 5).
Employ self-expanding metallic stents for palliative management of malignant anorectal strictures to achieve successful palliation in over 95% of cases (Evidence: Strong 5).
Consider biodegradable stents as a novel treatment option for refractory benign strictures, offering a temporary yet effective solution (Evidence: Moderate 3).
In pediatric patients undergoing complex procedures, meticulous anaesthetic management is crucial to avoid iatrogenic injuries (Evidence: Weak 1).
Multidisciplinary team involvement is essential for accurate staging and comprehensive management of malignant strictures, integrating various palliative techniques (Evidence: Expert opinion 4).References
1 Kamath PBRD, Krishna HM, Budania L, Nileshwar A. Iatrogenic tracheobronchial tear during paediatric thoracoscopic oesophageal repair: an anaesthetic challenge. BMJ case reports 2019. link
2 Shaw NM, Lobo JM, Zee R, Krupski TL. Management of Ureteroenteric Stricture: Predictive Modeling to Compare Cost. Journal of endourology 2016. link
3 Stivaros SM, Williams LR, Senger C, Wilbraham L, Laasch HU. Woven polydioxanone biodegradable stents: a new treatment option for benign and malignant oesophageal strictures. European radiology 2010. link
4 Lee SH. The role of oesophageal stenting in the non-surgical management of oesophageal strictures. The British journal of radiology 2001. link
5 Cowling MG, Adam A. Radiological management of oesophageal strictures. Hospital medicine (London, England : 1998) 1998. link
6 Hansen CP, Westh H, Brok KE, Jensen R, Bertelsen S. Bacteraemia following orotracheal intubation and oesophageal balloon dilatation. Thorax 1989. link
7 Rosen L. Anoplasty. The Surgical clinics of North America 1988. link44699-2)
8 De Sy WA. Aesthetic repair of meatal stricture. The Journal of urology 1984. link49821-1)